<?php 
/**
 * @package     LKVSolutions.JCMS
 * @subpackage  mod_checkdomain
 * @
 * @copyright   Copyright (C) 2014 - 2015 Open Source Matters, Inc. All rights reserved.
 * @license     GNU General Public License version 2 or later; see LICENSE.txt
 */

?>

<div class="checkdomain">
<form class="form-inline">	
	
     <input name="data" type="text" class="span4 search-query" placeholder="Search..." />
     
    <?php    
    echo jhtml::_('formbehavior.chosen','#mylistvalue');
    ?>
    
    <select id="mylistvalue" class="span1">
	    <option value="1" selected="selected">1</option>
	    <option value="2">2</option>
    </select>
    
    <input class="btn" type="submit" value="Search"/>
    
</form>
<div class="status"></div>
</div>